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Medicine is the " of maintaining and''or'' restoring Human Health through the Study , Diagnosis , and treatment of Patients . The term is derived from the medicina'' "the medical art," from ''medicus'' "physician."( Etym.Online )
The modern practice of medicine occurs at the many interfaces between ''the art of healing'' and various sciences. Medicine is directly connected to the Health Science s and Biomedicine . Broadly speaking, the term 'Medicine' today refers to the fields of clinical medicine, Medical Research and Surgery , thereby covering the challenges of Disease and Injury . , with its single snake, is an ancient Greek symbol associated with medicine. The American Medical Association , the American Osteopathic Association , the Royal Society Of Medicine , the Australian Medical Association , the British Medical Association , and the World Health Organization display the Rod Of Asclepius in their Logos or Emblems .]] OVERVIEW Since the 19th century, only those with a medical degree have been considered worthy to ''practice'' medicine. ''Clinicians'' (licensed professionals who deal with patients) can be physicians, physical therapists, physician assistants, nurses or others. The medical profession is the social and occupational structure of the group of people formally trained and authorized to apply medical knowledge. Many Countries and legal jurisdictions have Legal limitations on who may practice medicine. Medicine comprises various specialized sub-branches, such as Cardiology , Pulmonology , Neurology , or other fields such as sports medicine, research or public health. Human societies have had various different systems of health care practice since at least the beginning of recorded history. Medicine, in the modern period, is the mainstream scientific tradition which developed in the Western World since the early Renaissance (around 1450). Many other traditions of health care are still practiced throughout the world; most of these are separate from Western medicine, which is also called biomedicine, '''allopathic medicine''' or the Hippocratic tradition. The most highly developed of these are Traditional Chinese Medicine , Traditional Tibetan Medicine and the Ayurvedic Tradition s of India and Sri Lanka . Various non-mainstream traditions of health care have also developed in the Western world. These systems are sometimes considered companions to Hippocratic medicine, and sometimes are seen as competition to the Western tradition. Few of them have any scientific confirmation of their tenets, because if they did they would be brought into the fold of Western medicine. "Medicine" is also often used amongst medical professionals as shorthand for Internal Medicine . Veterinary Medicine is the practice of health care in Animal Species other than human beings. HISTORY OF MEDICINE Museum, Paris , France .]] See Also: History of medicine The earliest type of medicine in most cultures was the use of plants ( (the notion of inanimate objects having spirits); Spiritualism (here meaning an appeal to gods or communion with ancestor spirits); Shamanism (the vesting of an individual with mystic powers); and Divination (the supposed obtaining of truth by magic means), played a major role. The practice of medicine developed gradually, and separately, in Ancient Egypt , Ancient India , Ancient China , Ancient Greece , Ancient Persia and elsewhere. Medicine as it is practiced now developed largely in the late eighteenth century and early nineteenth century in England ( William Harvey , seventeenth century), Germany ( Rudolf Virchow ) and France ( Jean-Martin Charcot , Claude Bernard and others). The new, "scientific" medicine (where results are testable and repeatable) replaced early Western traditions of medicine, based on herbalism, the Greek " Four Humours " and other pre-modern theories. The focal points of development of clinical medicine shifted to the United Kingdom and the USA by the early 1900s (Canadian-born) Sir William Osler , Harvey Cushing ). Possibly the major shift in medical thinking was the gradual rejection in the 1400s during the Black Death of what may be called the 'traditional authority' approach to science and medicine. This was the notion that because some prominent person in the past said something must be so, then that was the way it was, and anything one observed to the contrary was an anomaly (which was paralleled by a similar shift in European society in general - see Copernicus 's rejection of Ptolemy 's theories on astronomy). People like Vesalius led the way in improving upon or indeed rejecting the theories of great authorities from the past such as Galen , Hippocrates , and Avicenna / Ibn Sina , all of whose theories were in time almost totally discredited. Such new attitudes were also only made possible by the weakening of the Roman Catholic church's power in society, especially in the Republic Of Venice . Evidence-based Medicine is a recent movement to establish the most effective algorithms of practice (ways of doing things) through the use of the Scientific Method and modern global Information Science by collating all the evidence and developing standard protocols which are then disseminated to healthcare providers. One problem with this 'best practice' approach is that it could be seen to stifle novel approaches to treatment. ampoules]] Genomics and knowledge of human genetics is already having some influence on medicine, as the causative Genes of most monogenic Genetic Disorder s have now been identified, and the development of techniques in Molecular Biology and genetics are influencing medical practice and decision-making. Pharmacology has developed from Herbalism and many drugs are still derived from plants (atropine, ephedrine, warfarin, aspirin, digoxin, vinca alkaloids, taxol, hyoscine, etc). The modern era began with Robert Koch 's discoveries around 1880 of the transmission of disease by bacteria, and then the discovery of Antibiotics shortly thereafter around 1900. The first of these was Arsphenamine / Salvarsan discovered by Paul Ehrlich in 1908 after he observed that bacteria took up toxic dyes that human cells did not. The first major class of antibiotics was the Sulfa drugs, derived by French chemists originally from Azo dyes. Throughout the twentieth century, major advances in the treatment of infectious diseases were observable in (Western) societies. The medical establishment is now developing drugs targeted towards one particular disease process. Thus Drugs are being developed to minimise the side effects of prescribed drugs, to treat cancer, geriatric problems, long-term problems (such as high cholesterol), chronic diseases Type 2 Diabetes , lifestyle and degenerative diseases such as Arthritis and Alzheimer's Disease . PRACTICE OF MEDICINE ]] The practice of medicine combines both Science as the evidence base and art in the application of this medical knowledge in combination with intuition and clinical judgment to determine the treatment plan for each patient. Central to medicine is the Patient - Physician relationship established when a person with a health concern seeks a physician's help; the 'medical encounter'. Other health professionals similarly establish a relationship with a patient and may perform various interventions, e.g. nurses, radiographers and therapists. As part of the medical encounter, the healthcare provider needs to:
The medical encounter is documented in a Medical Record , which is a legal document in many jurisdictions.1 Health care delivery systems Medicine is practiced within the Medical System , which is a legal, credentialing and financing framework, established by a particular culture or government. The characteristics of a health care system have significant effect on the way medical care is delivered. Financing has a great influence as it defines who pays the costs. Aside from Tribal cultures, the most significant divide in developed countries is between Universal Health Care and ''market-based health care'' (such as practiced in the U.S.). Universal health care might allow or ban a parallel private market. The latter is described as single-payer system. Transparency of information is another factor defining a delivery system. Access to information on conditions, treatments, quality and pricing greatly affects the choice by patients / consumers and therefore the incentives of medical professionals. While US health care system has come under fire for lack of openness , new legislation may encourage greater openness. There is a perceived tension between the need for transparency on the one hand and such issues as patient confidentiality and the possible exploitation of information for commercial gain on the other. Health care delivery See Also: clinic hospital hospice ]] Medical care delivery is classified into primary, secondary and tertiary care. Primary Care medical services are provided by physicians or other health professionals who have first contact with a patient seeking medical treatment or care. These occur in physician offices, Clinic s, Nursing Home s, School s, Home visits and other places close to patients. About 90% of medical visits can be treated by the primary care provider. These include treatment of acute and chronic illnesses, preventive care and health education for all ages and both sexes. Secondary Care medical services are provided by Medical Specialist s in their offices or clinics or at local community hospitals for a patient referred by a primary care provider who first diagnosed or treated the patient. Referrals are made for those patients who required the expertise or procedures performed by specialists. These include both Ambulatory Care and Inpatient services, Emergency Room s, Intensive Care Medicine , Surgery services, Physical Therapy , Labor And Delivery , Endoscopy units, diagnostic Laboratory and Medical Imaging services, Hospice centers, etc. Some primary care providers may also take care of hospitalized patients and deliver babies in a secondary care setting. Tertiary Care medical services are provided by specialist hospitals or regional centers equipped with diagnostic and treatment facilities not generally available at local hospitals. These include Trauma Center s, Burn treatment centers, advanced Neonatology unit services, Organ Transplant s, high-risk pregnancy, Radiation Oncology , etc. Modern medical care also depends on information - still delivered in many health care settings on paper records, but increasingly nowadays by electronic means. Patient-physician-relationship This kind of relationship and interaction is a central process in the practice of medicine. There are many perspectives from which to understand and describe it. An idealized physician's perspective, such as is taught in Medical School , sees the core aspects of the process as the physician learning the patient's symptoms, concerns and values; in response the physician examines the patient, interprets the symptoms, and formulates a diagnosis to explain the symptoms and their cause to the patient and to propose a treatment. The job of a physician is similar to a human biologist: that is, to know the human frame and situation in terms of normality. Once the physician knows what is normal and can measure the patient against those norms, he or she can then determine the particular departure from the normal and the degree of departure. This is called the diagnosis. The four great cornerstones of diagnostic medicine are '', which originally meant "teacher" in Latin . The Patient - Physician relationship is additionally complicated by the patient's suffering (''patient'' derives from the Latin ''patior'', "suffer") and limited ability to relieve it on his/her own. The physician's expertise comes from his knowledge of what is healthy and normal contrasted with knowledge and experience of other people who have suffered similar symptoms (unhealthy and abnormal), and the proven ability to relieve it with medicines ( Pharmacology ) or other therapies about which the patient may initially have little knowledge. The physician-patient relationship can be analyzed from the perspective of Ethical concerns, in terms of how well the goals of non-maleficence, beneficence, autonomy, and justice are achieved. Many other values and ethical issues can be added to these. In different societies, periods, and cultures, different values may be assigned different priorities. For example, in the last 30 years medical care in the Western World has increasingly emphasized patient autonomy in decision making. The relationship and process can also be analyzed in terms of social power relationships (e.g., by Michel Foucault ), or economic transactions. Physicians have been accorded gradually higher status and respect over the last century, and they have been entrusted with control of access to prescription medicines as a public health measure. This represents a concentration of power and carries both advantages and disadvantages to particular kinds of patients with particular kinds of conditions. A further twist has occurred in the last 25 years as costs of medical care have risen, and a third party (an Insurance company or government agency) now often insists upon a share of decision-making power for a variety of reasons, reducing freedom of choice of healthcare providers and patients in many ways. The quality of the Patient - Physician relationship is important to both parties. The better the relationship in terms of mutual respect, knowledge, trust, shared values and perspectives about disease and life, and time available, the better will be the amount and quality of information about the patient's disease transferred in both directions, enhancing accuracy of diagnosis and increasing the patient's knowledge about the disease. Where such a relationship is poor the physician's ability to make a full assessment is compromised and the patient is more likely to distrust the diagnosis and proposed treatment. In these circumstances and also in cases where there is genuine divergence of medical opinions, a ''second opinion'' from another physician may be sought. In some settings, e.g. the hospital ward, the patient-physician relationship is much more complex, and many other people are involved when somebody is ill: relatives, neighbors, rescue specialists, nurses, technical personnel, social workers and others. Clinical skills See Also: Medical history Physical examination A complete medical evaluation includes a Medical History , a systems enquiry, a Physical Examination , appropriate laboratory or imaging studies, analysis of data and medical decision making to obtain Diagnoses , and a treatment plan.2 The components of the medical history are:
The , Palpation (feel), Percussion (tap to determine resonance characteristics), and Auscultation (listen); smelling may be useful (e.g. infection, Uremia , Diabetic Ketoacidosis ). The clinical examination involves study of:
Laboratory and Imaging Studies results may be obtained, if necessary. The medical decision-making (MDM) process involves analysis and synthesis of all the above data to come up with a list of possible diagnoses (the Differential Diagnoses ), along with an idea of what needs to be done to obtain a definitive diagnosis that would explain the patient's problem. The treatment plan may include ordering additional laboratory tests and studies, starting therapy, referral to a specialist, or watchful observation. Follow-up may be advised. This process is used by primary care providers as well as specialists. It may take only a few minutes if the problem is simple and straightforward. On the other hand, it may take weeks in a patient who has been hospitalized with bizarre symptoms or multi-system problems, with involvement by several specialists. On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, and lab or imaging results or specialist consultations. BRANCHES OF MEDICINE Working together as an (s) emergency medical technicians and paramedics, laboratory scientists, (pharmacy, pharmacists), (physiotherapy,physiotherapists), Respiratory Therapists , Speech Therapists , Occupational Therapists , radiographers, Dietitian s and Bioengineers . The scope and sciences underpinning human medicine overlap many other fields. Dentistry and Psychology , while separate disciplines from medicine, are considered medical fields. ;Midlevel Practitioners: Nurse Practitioner s, Midwives and Physician Assistant s, treat patients and prescribe medication in many legal jurisdictions. ;Veterinary Medicine: Veterinarians apply similar techniques as physicians to the care of animals. The original focus of veterinary medicine was primarily the health care of domestic animals. In recent years the discipline has broadened to include all vertebrate animals and even some of the more economically valuable or scientifically interesting invertebrates. Veterinary and human medicine had similar origins but diverged in the West largely under the influence of Christian doctrine which emphasized a fundamental difference between humans and all other species. The two disciplines re-converged to some degree after the Renaissance when scientific study of anatomy and physiology revealed undeniable similarities between humans and other animals. The similarities further extend into pathology and disease control leading the early pioneer in scientific pathology Rudolph Virchow to proclaim the doctrine of "one medicine." Physicians have many specializations and subspecializations which are listed below. There are variations from country to country regarding which specialties certain subspecialities are in. Diagnostic specialties
Clinical disciplines being performed]]
Interdisciplinary fields Interdisciplinary sub-specialties of medicine are:
MEDICAL EDUCATION See Also: Medical education Medical school Medical education is education connected to the practice of being a medical practitioner, either the initial training to become a physician or further training thereafter. Medical education and training varies considerably across the world, however typically involves entry level education at a university Medical School , followed by a period of supervised practice ( Internship and/or Residency ) and possibly postgraduate vocational training. Continuing Medical Education is a requirement of many regulatory authorities. Various teaching methodologies have been utilised in medical education, which is an active area of educational research. Presently, in England, a typical medicine course at university is 5 years (4 if the student already holds a degree). Amongst some institutions and for some students, it may be 6 years (including the selection of an intercalated BSc - taking one year - at some point after the pre-clinical studies). This is followed by 2 Foundation years afterwards, namely F1 and F2. Students register with the UK General Medical Council at the end of F1. At the end of F2, they may pursue further years of study. In the USA, a potential medical student must first complete an undergraduate degree (Typically a BSc with a major in Biology , Biochemistry or Medical Science ), before applying to a graduate medical school to pursue the M.D. In Australia, students have two options. They can choose to take a six-year undergraduate Bachelor Of Medicine/Bachelor Of Surgery (MBBS) straight from high school, or complete a undergraduate degree and and then a four year Bachelor Of Medicine/Bachelor Of Surgery (BMBS) program. LEGAL RESTRICTIONS In most countries, it is a legal requirement for medical doctors to be licensed or registered. In general, this entails a medical degree from a university and accreditation by a Medical Board or an equivalent national organization, which may ask the applicant to pass exams. This restricts the considerable legal authority of the medical profession to physicians that are trained and qualified by national standards. It is also intended as an assurance to patients and as a safeguard against Charlatan s that practice inadequate medicine for personal gain. While the laws generally require medical doctors to be trained in "evidence based", Western, or Hippocratic Medicine, they are not intended to discourage different paradigms of health. CRITICISM Criticism of medicine has a long history. In the Middle Ages , some people did not consider it a profession suitable for Christians, as disease was often considered God-sent. God was considered to be the 'divine physician' who sent illness or healing depending on his will. However many monastic orders, particularly the Benedictines , considered the care of the sick as their chief work of mercy. Barber-surgeons generally had a bad reputation that was not to improve until the development of academic surgery as a speciality of medicine, rather than an accessory field. Through the course of the twentieth century, healthcare providers focused increasingly on the technology that was enabling them to make dramatic improvements in patients' health. The ensuing development of a more mechanistic, detached practice, with the perception of an attendant loss of patient-focused care, known as the Medical Model of health, led to further criticisms. This issue started to reach collective professional consciousness in the 1970s and the profession had begun to respond by the 1980s and 1990s. The noted anarchist , 1992, which criticises overreliance on technological means in medicine. Criticism of modern medicine has led to some improvements in the curricula of medical schools, which now teach students systematically on Medical Ethics , Holistic Approaches to medicine, the Biopsychosocial Model and similar concepts. The inability of modern medicine to properly address some common complaints continues to prompt many people to seek support from Alternative Medicine . Although most alternative approaches lack scientific validation, some may be effective in individual cases. Some physicians combine alternative medicine with orthodox approaches. Medical Error s and Overmedication are also the focus of many complaints and negative coverage. Practitioners of Human Factors Engineering believe that there is much that medicine may usefully gain by emulating concepts in Aviation Safety , where it was long ago realized that it is dangerous to place too much responsibility on one "superhuman" individual and expect him or her not to make Error s. Reporting systems and checking mechanisms are becoming more common in identifying sources of error and improving practice. SEE ALSO
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